罗库溴铵院外快速顺序气管插管成功率低于琥珀胆碱
2019-12-24   阅读:487   来源:Jama

法国留尼汪大学XavierCombes联合圣丹尼急诊科BertrandGuihard课题组的一项最新研究,探讨了罗库溴铵与琥珀胆碱对院外快速顺序气管插管成功率的影响。2019年12月17日,国际知名学术期刊《美国医学会杂志》发表了这一成果。

罗库溴铵和琥珀胆碱常用于快速顺序气管插管,但这些麻痹剂在紧急情况下插管的成功率尚未在临床试验中评估。琥珀胆碱常导致一些不良反应,而罗库溴铵则相对安全。

2014年1月至2016年8月,研究组在法国的17家医院进行了一项多中心、单盲、非劣效性、随机临床试验,共招募了1248例需行院外气管插管的患者,平均年龄56岁,女性占40.1%。将其随机分组,其中624例采用罗库溴铵,624例采用琥珀胆碱,均行快速顺序气管插管。

1226例患者纳入最终分析。罗库溴铵组的首次插管成功率为74.6%,低于琥珀胆碱组的79.4%,不符合非劣效性标准。最常见的插管相关不良事件为低氧血症和低血压,其中罗库溴铵组中的发生率分别为9.0%和6.4%,琥珀胆碱组中分别为9.9%和10.1%。

综上,在院外紧急情况下行气管插管的患者中,采用罗库溴铵的首次插管成功率低于琥珀胆碱。

附:英文原文

Title:EffectofRocuroniumvsSuccinylcholineonEndotrachealIntubationSuccessRateAmongPatientsUndergoingOut-of-HospitalRapidSequenceIntubation:ARandomizedClinicalTrial

Author:BertrandGuihard,CharlotteChollet-Xémard,PhilippeLakhnati,BenoitVivien,ClaireBroche,DominiqueSavary,AgnesRicard-Hibon,Pierre-JeanMarianneditCassou,FrédéricAdnet,EricWiel,JulietteDeutsch,CindyTissier,ThomasLoeb,VincentBounes,EmmanuelRousseau,PatriciaJabre,LaetitiaHuiart,CyrilFerdynus,XavierCombes

Issue&Volume:2019/12/17

Abstract:

ImportanceRocuroniumandsuccinylcholineareoftenusedforrapidsequenceintubation,althoughthecomparativeefficacyoftheseparalyticagentsforachievingsuccessfulintubationinanemergencysettinghasnotbeenevaluatedinclinicaltrials.Succinylcholineusehasbeenassociatedwithseveraladverseeventsnotreportedwithrocuronium.

ObjectiveToassessthenoninferiorityofrocuroniumvssuccinylcholinefortrachealintubationinout-of-hospitalemergencysituations.

Design,SettingandParticipantsMulticenter,single-blind,noninferiorityrandomizedclinicaltrialcomparingrocuronium(1.2mg/kg)withsuccinylcholine(1mg/kg)forrapidsequenceintubationin1248adultpatientsneedingout-of-hospitaltrachealintubation.EnrollmentoccurredfromJanuary2014toAugust2016in17Frenchout-of-hospitalemergencymedicalunits.Thedateoffinalfollow-upwasAugust31,2016.

InterventionsPatientswererandomlyassignedtoundergotrachealintubationfacilitatedbyrocuronium(n = 624)orsuccinylcholine(n = 624).

MainOutcomesandMeasuresTheprimaryoutcomewastheintubationsuccessrateonfirstattempt.Anoninferioritymarginof7%waschosen.Aper-protocolanalysiswasprespecifiedastheprimaryanalysis.

ResultsAmong1248patientswhowererandomized(meanage,56years;501[40.1%]women),1230(98.6%)completedthetrialand1226(98.2%)wereincludedintheper-protocolanalysis.Thenumberofpatientswithsuccessfulfirst-attemptintubationwas455of610(74.6%)intherocuroniumgroupvs489of616(79.4%)inthesuccinylcholinegroup,withabetween-groupdifferenceof−4.8%(1-sided97.5%CI,−9%to∞),whichdidnotmeetcriteriafornoninferiority.Themostcommonintubation-relatedadverseeventswerehypoxemia(55of610patients[9.0%])andhypotension(39of610patients[6.4%])intherocuroniumgroupandhypoxemia(61of616[9.9%])andhypotension(62of616patients[10.1%])inthesuccinylcholinegroup.

ConclusionsandRelevanceAmongpatientsundergoingendotrachealintubationinanout-of-hospitalemergencysetting,rocuronium,comparedwithsuccinylcholine,failedtodemonstratenoninferioritywithregardtofirst-attemptintubationsuccessrate.

DOI:10.1001/jama.2019.18254

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